What waters democracy - bodily autonomy
I’ve often said that there is very little that is considered holy in the western world. Two things that are, are freedom of speech and bodily autonomy. I’m not sure how true that statement is anymore. It seems that in terms of these democratic cornerstones, time is moving backgrounds in our part of the world. I believe that people who work in the field of medicine hold a certain accountability to the latter of the two sacraments: the right to bodily autonomy.
Bodily autonomy is a phrase describing every individual’s right to make decisions about their own body, free from interference or coercion by external forces. Debates surrounding this topic are often centred around women’s reproductive rights, and rightly so. Women’s access to birth control and abortion, as well as the culture around it, bears immense political weight. But the topic of bodily autonomy goes far beyond reproductive rights. Bodily autonomy acts as a buffer to totalitarianism, and is as central to maintaining a healthy democracy as the freedom of speech.
Totalitarianism gives rise to the elimination of individualism, in favour of collectivism. This includes suppressing the idea that the individual is capable of exercising autonomy in every area of life, as they no longer belong to themselves but rather to the larger, vastly more important political party. The aim is to remove control from the individual, and place all control into the hands of the state. Often in this situation the “us versus them” mentality takes over. The countless historical examples of this should serve as reminders of the horrors this kind of thinking produces.
Most famously, in Nazi Germany the infringement of bodily autonomy resulted in a mass genocide and brutal medical experimentation upon a wide range of minorities. Even within the population that wasn’t persecuted, the Nazi Party had every intention of removing the principle of bodily autonomy. They did this by penalising homosexuality, increased punishments for those performing abortions, and pressuring young people to join Hitler youth, where they were indoctrinated with the Nazi ideology, which included the idea that their body belonged to the reich. Hitler wrote in Mein Kampf, that “We must also do away with the conception that the treatment of the body is the affair of every individual.” (Ralph Manheim Translation). Absolute devotion to the party required the death of individualism, pushing the idea that one’s body does not belong to oneself is an excellent way to oppress a population and force them into compliance.
Another example (and a book recommendation) that highlights the effects of the loss of bodily autonomy is detailed in the dystopian novel “Brave New World” by Aldous Huxley. As is typical in dystopian fiction, the government, in this novel called ”The World State”, aims to be all controlling, and any person straying from the path set by The World State must be punished. They gain control through technological advancements, that provide instant gratification, that the people mistake for happiness. They encourage the population to take high doses of the drug “soma”, which dampens negative feelings and increases complacency. The philosophy of The World State is that truth and happiness is incompatible, and truth should therefore be avoided in order to preserve happiness, despite it being shallow and impulse-driven. Everyone in Brave New World is so superficially happy, that they don’t care about their personal freedoms, and the concept “for the greater good” becomes so internalised that autonomy loses its value. I’m sure it’s not difficult to find a parallel to the instant gratification and impulse-driven happiness described in the book in our society today.
How does all this relate to us medical professionals? Our position makes us a valuable link in democracy, as we control what information is given to the patients. We determine the quality of knowledge they have, and thus how well they are equipped to make decisions about their bodies, health, lifestyle, treatment, and ultimately how they practise their bodily autonomy. Not only are we bound by law to provide this information, it is also required that the communication is appropriate according to the patient’s circumstances, this includes: age, education, emotional state, cultural and religious background. The way we communicate has influence over the patient’s understanding of their condition, and therefore their ability to make an informed decision. It is vital that we understand that this is not just about presenting facts, but engaging in dialogue, asking questions, understanding the patient’s point of view and offering guidance in a way that respects the patient’s values and choices.
Imagine if this is not done properly, or if we lived in a culture where it was commonplace for you to accept whatever treatment your doctor offered, without question. The quality of healthcare would definitely suffer, and the right to bodily autonomy would be infringed upon. It may seem far fetched, but this is a very real scenario. Between 1966-1970 Danish doctors inserted roughly 4500 IUD’s into Greenlandic women and girls as young as 13 years old. That accounted for roughly half of Greenlands female population of childbearing age, at that time. Not all of the women and girls gave their consent, or were informed properly of possible side effects. This was highly unethical and left many women infertile, and try considering the democratic implications. Political power rests with the majority, the population size of a country like Greenland is very relevant to its political influence. This IUD campaign had an effect on Greenland’s population growth, and by extension the country’s political relevance.
It is also important to note the right not to know the extent of one’s illness, or what one’s treatment exactly entails. Here it is our job to ensure the patient understands the ramifications of being unable to make an informed decision. In this scenario, the patient is bestowing the highest degree of trust upon their doctor to act in their best interest. It is exceedingly important that this isn’t taken advantage of, for the sake of the integrity of our profession.
Effective communication is key for patients to be able to exercise bodily autonomy, but the responsibility of medical professionals exceeds this. In order to safeguard bodily autonomy, we must be critical of the entity that has influence over its framework: our government. Legislation doesn’t always align with what some consider to be ethical, especially in healthcare. Medical professionals are not exempt from the law in any way, but we must refuse to blindly accept laws that possibly interfere with the patient’s ability to exercise their bodily autonomy.
I believe that legislation in the areas of our personal freedom, must be made with extreme caution. In history, the compromise of democratic rights never happened overnight, but was slowly instilled, like water dripping into a glass. The change in volume seems insignificant at first, and when the glass spills over it’s too late.
Another factor crucial to take into account is the increasing amount of misinformation circling social media, and the threat it poses to the wellbeing of patients. Social media is currently sculpting what society perceives as normal, desirable and acceptable for our bodies - but it is not free from misinformation. What differs social media as a source for information from traditional sources such as newspapers, is that social media is a debate platform where each user contributes with content, but without that content needing to be fact checked. News outlets with any journalistic integrity would be disregarded for providing false information, but that is exactly what social media feeds upon. What people see on social media without a doubt affects their perception of their body, and what kind of control they have over it. In our conversations with patients we must focus on not entertaining false notions that may be harmful, but keeping their expectations realistic and encouraging understanding of the truth that we can provide.
Democracy is not a guarantee, it is only in place while society nurtures it by practising the right to vote, right to assembly, freedom of speech and bodily autonomy. We who work as medical professionals must promote patients’ autonomy by encouraging communication, and ensuring they are equipped with the knowledge necessary for them to make an informed decision concerning their body. It is vital that we remain critical, engage in societal debate and promote truth in our field of profession, so that the people’s right to autonomy is protected.
Af Kirsten//MOK
Årg. 57, Nr. 12